Following the signing of the concordat on Winterbourne View, there was a commitment to producing a report on progress against the agreements made by the signatories of that document .
This report was published earlier this month and reports the findings from a questionnaire administered to all the 152 health and well-being board areas.
The concordat identified that there was a need to bring back people who were described as having challenging behaviour, who were living in ‘Winterbourne View style hospitals’
The stocktake questionnaire covered 11 key areas :
- Models of partnership
- Understanding the money
- Case management for individuals
- Current review programme
- Commissioning arrangements
- Developing local teams and services
- Prevention and crisis response capacity
- Understanding the population who may need/receive services
- Children and adults transition planning
- Current and future market requirements
The analysis of findings suggests that all localities are engaging and working on the Concordat commitments and that there is evidence of leadership supporting change. They found that although there was evidence of service user and family carer engagement, it was not always consistent within areas and not happening in all areas.
There was some evidence of integrated and joint working in assessment, commissioning and service development, but again this was not found consistently across all areas
Interestingly, the report suggests that working with the newly formed Clinical Commissioning Groups is one of the factors that has added fresh impetus to the work in some localities
In addition there were some concerns raised, for example:
The need to clarify who is to be considered as part of the change and the need for localities to work together within and across geographical boundaries to achieve longer term sustainable solutions
In line with the thinking established many years ago in the Mansell reports, there was a continuing need to invest in skills and infrastructure for behaviour support and local community based accommodation options
One key issue uncovered by the stocktake was a continuing concern about the lack of a clear joint commissioning approach between the NHS CCGs and local authorities.
As a large number of the people placed in such services are typically funded by NHS commissioners, moving back to local services would mean costs for support other than healthcare needs being met by local authorities. The original Department of Health review was clear that local authorities should not be financially disadvantaged by the return of people to their localities, calling for the NHS to come to local agreements about transfer of funds or pooled funding arrangements.
The stocktake found:
- 30% of areas reported a pooled budget and just under 40% stated that funding contributions had been agreed from councils and CCGs.
- 60% of areas reported that they had reached a shared understanding across councils and NHS of the total costs of the current services.
- 57% of areas had requested support from the Winterbourne View Joint Improvement Programme, which aims to offer bespoke support packages to areas and provide resources to regional local government and NHS networks.
In line with the approach recently announced by CQC, the Joint Improvement Programme will also carry out what are described as “deep dive” assessments of progress, which may identify good practice to share as well as uncover areas of concern.
The stocktake also uncovered more than 340 examples of good practice which will be analysed with the Social Care Institute for Excellence (SCIE) and NHS England in order to ensure that this learning is fully shared..
You can download the reports here:
NHS England and Local Government Association: Winterbourne View joint improvement programme Stocktake of progress report